The size of catheters: an important parameter to consider in assessing infectivity

Type of article: Mini review

Sidi Mohammed Lahbib Seddiki*1,2, Zahia Boucherit-Otmani2

1: University Center of Naâma, Algeria

2: Laboratory: Antifungal Antibiotic, Physico-Chemical Synthesis and Biological Activity, University of Tlemcen, Algeria

Abstract

The diagnosis of catheters’ infectivity is established considering several parameters. These relate to the clinical patients’ data and the microbial load of the catheters following their culture. Catheter infectivity type is related to the significance threshold. However, differences in sizes exist between several catheters. So, in order to qualify any microbial alteration, it is important to take into account the impact of the size of the catheters. For this, future studies should consider this parameter to assess microbial load properly.

Key words: Catheters; Infectivity; Diagnosis; Microbial Colony Forming Unit.

Corresponding author:Sidi Mohammed Lahbib Seddiki,University Center of Naâma, Algeriaseddiki.med@gmail.com

Received: 1 February, 2019, Accepted: 16 Mars, 2019, English editing: 16 Mars, 2019, Published: 01 April, 2019.

Screened by iThenticate..©2017-2019 KNOWLEDGE KINGDOM PUBLISHING.

1.   Important concepts

The ascertainment of this article is the result of several published studies. Despite notable progress in the study of microbial infectivity of catheters, which refer to their degree of bacterial and/or fungal alteration, the determination and distinction of catheter infection versus simple contamination remain the primary objective for clinicians before making an appropriate antimicrobial therapeutic decision.

Since the publication of the work in [1] which focused on the semi-quantitative method of culture and identification of catheter-related infections, discussion of the sensitivity and specificity of a better technique for diagnosing catheter infectivity is still needed. Unlikely, Cleri and his team [2] proposed in 1980 a quantitative technique to examine catheters after removal of patients. Seven years later, Brun-Buisson et al. [3] modified the Cleri technique to obtain results that are more reliable. Recently, our team proposed the combination of two quantitative techniques for the evaluation of microbial infectivity of catheters [4]. While, it should be interesting to remember the following concept; Colony-Forming Unit (CFU) counting entails microbe culturing and counting only viable cells, in contrast with the microscopic investigation to compute the amount of all types of cells, living or dead. [5]

In order to guide their studies, many authors agree on the collection of clinical data of patients with altered catheters. These data mainly concern the prognosis of the disease, the treatment regimen, the type of implanted catheter and its implantation duration. [2, 3, 6, 7,8].

Besides, the diagnosis of catheter infection is based on clinical and microbiological criteria [6,9], which are often marked by the presence of local or systemic signs of infection [10].

Indeed, the infection of the catheter is evidenced by its positive culture with a threshold of significance [11]. In this context, several proposals have been made. A threshold of 15 CFU to define the existence of significant colonization of the catheter appeared in [1], but the work in [13] reported it at ≥ 50 CFU. On the other hand, the threshold was lowered in [14] to 5 CFU to increase the sensitivity of the technique, whereas a threshold of 25 CFU would be more specific for the diagnosis of infection according to [12]. Otherwise, the threshold value for quantitative techniques is 103 CFU / mL [3] or 103 cells / mL [8].

Anyway, for many catheters other than peripheral vascular ones, which are characterized by their relatively large size, infectivity evaluation should consider the size of the catheter. This concerns the length of the removed portion of the catheter and its diameter (Figure 1).

Figure 1: Fragment of a urinary catheter taken from an inpatient in the intensive care unit-Sidi Bel Abbes University Hospital - Algeria. Use of sterile graduated rule.

Catheters can have a large variety of sizes, constituents and types. Clinician has to keep in mind numerous factors, e.g., medical necessity, expected time of use, individual choice and the infection risks involved [15, 16].

For these reasons, we suggest for greater precision, that the results of the CFU / mL or cell / mL evaluation be supplemented by the unit length. Conversely, the neglect of these last two parameters, the length of the removed part of the catheter and the diameter thereof, may lead to visibly erroneous results as to the microbial load of the catheter removed; therefore, the significance level will be incorrect.

1.   Conclusion

The diagnosis of catheter infectivity involves several parameters related to the clinical information of the patient and the microbial presence on the catheter after culturing. The catheter infectivity type is related to the level of significance. Nevertheless, differences in dimensions do exist between several kinds of catheters. For this, future studies should contemplate this parameter to properly evaluate the microbial load.

2.   Acknowledgment

We would like to thank Dr. Asma Kebiri for reading the English version of this article.

3.   Conflict of interest statement

We certify that there is no conflict of interest with any financial organization in the subject matter or materials discussed in this manuscript.

4.   Authors’ biography

 No Biography

5.   References

[1].  Maki,  DG,  Jarretf  F,  SarafinHW.  1977.  A  semi  quantitative  culture  method  for identification  of  catheter-related  infection  in  the  burn  patient.  J.  Surg.  Res.  22(5):  513-520. https://doi.org/10.1016/0022-4804(77)90034-8

[2]. Cleri DJ, Corrado ML, Seligman SJ. 1980. Quantitative Culture of Intravenous Catheters and Other Intravascular Inserts. J. Infect. Dis. 141(6): 781-786. https://doi.org/10.1093/infdis/141.6.781

[3].  Brun-Buisson  C,  Abrouk  F,  Legrand  P,  Huet  Y,  Larabi  S,  Rapin  M.  1987.Diagnosis  of central  venous  catheter-related  sepsis:  critical  level  of  quantitative  tip  cultures.  Arch.  Intern. Med. 147(5): 873-877. https://doi.org/10.1001/archinte.147.5.873

[4].   Seddiki   SML,   Boucherit-Otmani   Z,   Mahdad   YM,   Bendahmane   AF,   Kunkel   D. 2018.Proposition of an appropriate technique to diagnose catheters fungal infectivities.JKSUS. 30(3) : 400-403. https://doi.org/10.1016/j.jksus.2018.04.012

[5].  Goldman,  Emanuel;  Green,  Lorrence  H  2008. Practical  Handbook  of  Microbiology, Google eBook, 2nd ed., CRC Press, Taylor and Francis Group. p. 864.ISBN 978-0-8493-9365-5.Retrieved 2018-10-16.

[6].  Carrière  C,  Marchandin  H.  2001.  Infections  liées  aux  cathéters  veineux  centraux  : diagnostic et définitions. Néphrologie. 22(8): 433-437.

[7].  Mermel  LA,  Farr  BM,  Sheretz  RJ,  Raad  II,  O'Grady  N,  Harris  JS,  Craven  DE.  2001. Guidelines for the management of intravascular catheter-related infections. Clin. Infect. Dis. 32(9): 1249-1272. https://doi.org/10.1086/320001

[8]. Seddiki SML, Otmani-Boucherit Z, Boucherit K, Badsi-Amir S, Taleb M, Kunkel D. 2013. Assessment  of  the  types  of  catheter  infectivity  caused  by  Candida  species  and  their  biofilm formation.First   study   in   an   intensive   care   unit  in   Algeria.   Int.   J.   Gen.   Med.   6,   1-7. https://doi.org/10.2147/IJGM.S38065

[9]. Ryan JA, Abel RM, Abbott WM, HopkinsCC, Chesney TM, Colley R, Phillips K, Fischer JE.1974.  Catheter  complications  in  total  parenteral  nutrition.A  prospective  study  of  200 consecutive patients. N. Engl. J. Med. 290(14) : 757-761. https://doi.org/10.1056/NEJM197404042901401

[10].  Domart  Y., Hoen  B,  Leport  C,  Cartier  F,  le  Groupe  de  travail  sur  les  infections cardiovasculaires.  1991.  Traitement  curatif  des  infections  sur  cathéter  veineux  central  en fonction  du  germe,  de  la  situation  clinique  et  du  type  de  cathéter  (cathéter  en  place  ou  après ablation). Propositions, limites.Nutr.Clin.Métabol. 5(2) 95-104. https://doi.org/10.1016/S0985-0562(05)80116-5

[11]. Brun-Buisson C. 1994. Analyse critique des méthodes diagnostiques d'infection liée au cathéter sur matériel enlevé. Réan.Urg.3 (3 bis) 343-346.https://doi.org/10.1016/S1164-6756(05)80726-1

[12]. Rello J, Cell P, Prats G. 1991. Laboratory diagnosis of catheter-related bacteremia. Scand. J. Infect. Dis. 23(5): 583-588. https://doi.org/10.3109/00365549109105182

[13]. Snydman DR, Gorbea HF, Pober BR, Majka JA, Murray SA, Perry LK. 1982. Predictive value  of  surveillance  skin  cultures  in  total  parenteral  nutrition-related  infections.  Lancet. 18(2):1385-1388. https://doi.org/10.1016/S0140-6736(82)91281-8

[14].  Collignon  PJ,  Seal  N,  Pearson  IY,  Woods  WP,  Munro  R,  Sorrell  TC.  1986.  Is  semi-quantitative culture of central vein catheter tips useful in the diagnostic of catheter associated bacteremia? J. Clin. Microbiol. 24(4): 532-535.

[15]. Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. 2013. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary   tract   infection:   an   integrative   review.BMJ   quality   &   safety,   23(4),   277-89. https://doi.org/10.1136/bmjqs-2012-001774

[16]. Cai Z, Chattopadhyay N, Liu WJ, Chan C, Pignol JP, Reilly RM 2011. Optimized digital counting  colonies  of  clonogenic  assays  using  ImageJ  software  and  customized  macros: comparison     with     manual     counting.     Int     J     Radiat     Biol.     87     (11):     1135-46. https://doi.org/10.3109/09553002.2011.622033